4 “Art and science have their meeting point in method.”Earl Edward George Bulwer-Lytton (1875)4

5 “Art and science have their meeting point in method.”Earl Edward George Bulwer-Lytton (1875)ditto

6 Our Overarching GoalTo prevent illness and death by gathering and analyzing information to create collective knowledge and stop food problems before they happen

7 Foodborne Illness Source Attribution: What is it?My vision is a slide with the first 2 questions. Then next slide adds a picture, maybe of lotsOf people frantically doing everything, saying the 3rd quote.Foodborne Illness Source Attribution: What is it?at·tri·bu·tion: [a-trə-byü-shən]The act of attributing, especially the act of establishing a particular person as the creator of a work of art.<The American Heritage® Dictionary of the English Language>The act of attributing, especially specifically the act of establishing a particular person food as the creator source of an work of art infection.

9 Attribution of Illnesses to Food SourcesWe need to use new tools to understand today’s food safety challengesUsing these tools, we will paint a clearer picture of foodborne illness source attribution9

11 Cycle of Foodborne Disease Control and PreventionSurveillancePreventionMeasuresEpidemiologicInvestigationFamiliar cycle of foodborne disease control and preventionAppliedResearch

12 Cycle of Foodborne Disease Control and PreventionSurveillanceOUTBREAKPreventionMeasuresEpidemiologicInvestigationThis is where attribution starts—at the time of an outbreak investigation. CDC has been doing this for decades.AppliedResearch

13 Investigating the Source of OutbreaksEscherichia coli O157 outbreaks in mid 1980’s and early 1990’s traced to ground beefInformation used to guide interventions taken by regulatory agencies:Recommended minimum cooking temperature of hamburgers was raisedFood Safety Inspection Service (FSIS):Implemented HACCP (Hazard Analysis and Critical Control Points)Made E. coli O157 an adulterant in ground beef13

14 Foodborne Disease Outbreak Surveillance SystemfdossCaptures outbreak data on agents, foods, and settings responsible for illnessDeveloped: 1967, standardized in 1973Because: Outbreaks are the major way we learn what foods are causing illness and how to prevent it.Now: States report hundreds of outbreaks each year through the National Outbreak Reporting System (NORS). The data is used to determine pathogen-food combinations to target for prevention.

22 3 Steps to Improved UnderstandingStep 1: Estimate total number of annual US foodborne illnesses caused by each pathogenStep 2: Attribute illnesses to foodsStep 3: Determine the top priority pathogens and their food sources

23 3 Steps to Improved UnderstandingStep 1: Estimate total number of annual US foodborne illnesses caused by each pathogenStep 2: Attribute illnesses to foodsStep 3: Determine the top priority pathogens and their food sources

25 Annual estimate of domestically acquired foodborne illnesses caused by 31 known pathogensNearly 48 million illnesses, resulting in ~128,000 hospitalizations, 3,000 deaths7 pathogens cause 90% of illnesses, hospitalizations, and deaths due to known pathogensSalmonella, norovirus, Campylobacter, Toxoplasma, E. coli O157, Listeria, and Clostridium perfringensFive pathogens account for 88% of hospitalizations caused by known pathogensSalmonella, norovirus, Campylobacter, Toxoplasma, E. coli O1571/28: same comment as before: Title should be “Illnesses and…” or better, delete hosp, just say “Caused by 31 known pathogens”Slide is very crowded. I would delete last 2 bullets.Delete underline of “known pathogens”25

26 3 Steps to Improved UnderstandingStep 1: Estimate total number of annual US foodborne illnesses caused by each pathogenStep 2: Attribute illnesses to foodsStep 3: Determine the top priority pathogens and their food sources

28 3 Steps to Improved UnderstandingStep 1: Estimate total number of annual US foodborne illnesses caused by each pathogenStep 2: Attribute illnesses to foodsStep 3: Determine the top priority pathogens and their food sources

30 Determining Major Food SourcesUsing data from outbreaks caused by simple foods to attribute illnesses to commodities paints a picture of the pathogen-food commodity pairs that contribute to foodborne disease

32 Limitations of Outbreak DataOutbreaks account for a small proportion of total number of foodborne illnessesNeed methods that encompass a larger proportion of foodborne illnessesMulti-stateData from Foodborne Diseases Active Surveillance Network (FoodNet) and Foodborne Disease Outbreak Surveillance System

33 Limitations of Outbreak DataMore than half of foods reported are complexMany outbreak investigations don’t implicate a single foodSmall outbreakDelay in reporting to public health departmentNot all pathogens contributing to foodborne disease cause outbreaks: Toxoplasma gondii

37 The Power of NumbersIn the early 1980’s outbreaks of Salmonella Enteritidis were increasing in the NortheastOnly 7 of 35 (20%) outbreaks specifically implicated eggsWhen outbreaks due to egg-containing foods examined, 27 of 35 outbreaks (77%) were associated with eggsOutbreaks in the NortheastOutbreaks in the rest of the countryNeed to add text box labeling the 2 linesSt. Louis et al. JAMA 1988

38 Estimating the Number of Illnesses Attributed to Each Food CommodityCDC has developed a method to use data from both simple and complex food outbreaks to estimate how many illnesses can be attributed to each food commodityTitle sounds like scallan paper. I think title better “…attributed to each food commodity”Be sure to remove the numbers and label from y axis!!I find the text a bit obtuse. How about something like: CDC has developed a method to use data from both simple and complex food outbreaks to estimate how many illnesses can be attributed to each food commodityPainter et al. submitted

40 Case-control Studies Sources of illness are usually not knownIll people are not routinely interviewed unless part of an outbreak or a special study , such as a case-control studyPeople who are sick cannot determine what food (or other exposure) made them sick, and interviewer can’t eitherExposure to contaminated source often days, even weeks, before illnessCase-control studies ask about many exposures, compare exposures of ill persons and non ill persons to identify likely sources, but do not identify the source of an individual illnessGood. Would put in beginning of this section after you explain that 80% are not outbreaks (not more than 80%?).

47 Challenge: Communicating ClearlyHow to explain uncertainty associated with different estimatesHow to interpret “change”Changing dataDifferent methodsReal changeWhat it means to consumers for a food to be “risky”: how to provide information that helps consumers without generating fearI would delete this slide

48 My vision is a slide with the first 2 questionsMy vision is a slide with the first 2 questions. Then next slide adds a picture, maybe of lotsOf people frantically doing everything, saying the 3rd quote.Looking ForwardAttribution estimates are always changing:Data is improvingNew data sources are being incorporatedAnalytic methods continue to evolveOur goal is to continue to improve estimates by using the best available data and methods, which will enable us to use the most current, accurate, state-of-the-art information when making decisions.

50 Thank You! Would consolidate last 2 slidesThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.National Center for Emerging and Zoonotic Infectious DiseasesEnteric Diseases Epidemiology Branch

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